Provider Demographics
NPI:1528239951
Name:RYAN, THOMAS J (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 FRANKLIN HEALTH COMMONS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938
Mailing Address - Country:US
Mailing Address - Phone:207-778-6031
Mailing Address - Fax:207-779-2240
Practice Address - Street 1:20 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1891
Practice Address - Country:US
Practice Address - Phone:207-532-2900
Practice Address - Fax:207-532-5974
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA228303207R00000X
ME2076208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine